Surgical options for advanced renal cell carcinoma

Detection of advanced renal cell carcinoma (RCC) is not uncommon, although there has been a stage migration due to frequent use of abdominal imaging allowing early detection of renal masses. Since open IVC thrombectomy was introduced in 1972, minimally invasive approaches such as laparoscopic approach, hand-assisted approach and robotic approach have been adopted. While robotic surgery has potential benefits to improve perioperative outcomes, and our experience with robotic surgery has grown significantly over the last decade, open surgery at an academic center remains the standard of care in this setting. In the setting of metastatic RCC, cytoreductive nephrectomies have been discussed for many years but their indications are unclearly defined, although cytoreductive nephrectomy can be considered in patients with disease largely limited to the kidney or on-going or impending symptomatic disease. Significant advances have been made in systematic therapy for RCC which will eventually lead to the evolution of neoadjuvant and adjuvant therapy in patients with advanced RCC. The surgical management of advanced RCC is a major and complex undertaking but has shown to be feasible and effective.